Marci got me started with listening to This American Life.  It's a radio program, broadcast by Public Radio International (PRI).  For the last couple of months, I've been downloading their weekly podcast and enjoying the program while I bike throughout Amsterdam.  My main reasons for enjoying the program are its artistry and entertainment.  Just plain good storytelling.  But this week's episode about health care in the United States was not just entertaining and artistic (as usual), but also remarkably educational.

Health-care in the USA a very worn-out topic, but I feel that this piece covered it from some angles that I had never heard before.  You'd have to hear the whole episode to know what I'm really talking about, but I was particularly intrigued by one anecdote from "Act 2" of the program.

It tells the story of a teenage girl who was in a minor car wreck.  As a precaution, she was brought into ER, with her neck stabilized as a precaution against potential spinal injury.  When the doctor on the scene performed some manual exams, he was able to determine that a fracture was extremely unlikely and that the girl was, in fact, not seriously injured.  When the girl's father showed up, however, the doctor was confronted with a very different situation:  "a very tall, very powerful figure who was very upset and spoke very loudly and he also happened to mention that he was a lawyer and that there would be consequences for anyerror that we made."  Basically, in spite of the physician's professional opinion, the teenaged girl's father demanded not just an x-ray but a CAT scan, which involves significantly greater cost and greater exposure to radiation.  As the doctor explained on the program, the dangers that an otherwise healthy girl would face by taking an unneccessary CAT scan could eventually result in not just trivial harm, but "important harm" (for example, a greater risk of thyroid cancer later in life).  But the father persisted in his aggressive tactics, insisting on a CAT scan.  Again, the doctor was 99.9% sure that a CAT scan would be more harmful than beneficial to the patient, but he was faced by a dilema that he was suddenly able to articulate to the patient's father, like an epiphany, as he explained to him below:

 "You know, for me it really is the right thing to do the CAT scan.  If I don't do the CAT scan, you're probably going to lodge a complaint about me; if I do the CAT scan, you're going to be really happy with me.  In addition, I'm almost certain that your daughter is fine; but there's a, maybe, one in a million chance that she isn't, that there really is a hidden factor and I'm missing it.  If that's the case, then the CAT scan will save my butt.  On the other hand, if I do the CAT scan and your daughter gets a cancer, maybe 20 years from now, no one will blame me.  In addition, I'm spending a lot of time talking to you here that I need to be going and doing other things.  If I got the CAT scan, I could do it in a second.  It would be done with; it would be easy.  Finally, the really strange thing is that I'll get paid more if I do the CAT scan.  With the way that  bills are made, you get paid more for more complex patients.  The insurance companies of the world think that it proves that the patient was more complex and more difficult if you had to do a CAT scan!  So everything about this was pushing me to do the CAT scan.  There's only one problem:  which is that when I decided to become a doctor, I made a pledge.  And the pledge was that I would put my patients' interests in front of my own interests.  In this case, my judgment was that it was not in my patient's interest to do the CAT scan, and therefore I can't do it."

Eventually, the father of the daughter from the car accident elected not to press the issue further, and the doctor's judgment stood.  But the whole situation dramatically illustrated many of the problems facing health care in the United States of America.

I've run across many of these same dilemas, first-hand, since moving to the Netherlands and experiencing a different health care system.  To be honest, the Dutch system has often frustrated me, the disgruntled American patient.   But I've been learning about how things can be done differently.  And the above-mentioned broadcast helped to make things even more clear.  Perhaps you'd be as interested in listening to it as I was.